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HomeMy WebLinkAboutBuilding Permit Application i ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: ���• 1 WE _ Building Permit Application Planning and Development Services Building and Code Regulation Division 2300 Virginia Avenue,Fort Pierce FL 34982 Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential / PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line j- Address, Legal Description: Property Tax ID#: 000 j Lot No. Site Plan Name: Block No. Project Name: i Setbacks Front Back: Right Side: Left Side: DETP►ILED DESCRIPTION CSF`WORK r'Rk l T aM � a x fi ,9,00AMP DoUk oN P�DfsTR I i�11�E t'!lF� i^'/oiGP.S Jl� ol` DCP90VlDE, 3- I�,OV6ff PEeF-PT4CLES Ftp? G AEP vse, CONSTRUCT{ON I�iF4RMA "ION � � � r T - Additional work to be nerrormed under this permit–check all appy: HVAC Gas Tank ❑Gas Piping _Shutters ❑Windows/Doors Electric Plumbing Sprinklers E]Generator Roof Total Sq.Ft of Construction: S Ft.of First Floor: Cost of Construction:$ .�J(`) a o Utilities: _Sewer F]Septic Building Height: OWNER LES5EE Name d` P-S, Name- 1Ak o,,– 6-AjGELm'ttaJ Address: U33,1 S 1/V1)P1rU I?IJEP_ b,<1 Company: 11eU14A'1E 6L6CT�ICd' C01,JTAC1-166, wd City: -,'5-ENSF-N c/y State:FL Address: 7173 Ql0Q7!' p` Zip Code: 3 LN57 Fax: City: 1'o17.T ST "G.ue lE State• EL Phone No. S�1—7a5--7,-15,5� Zip Code: -3 Fax: .E-Mail:_ --'C®T/-P-i A-S-rZ-AAbSG4PiAX, C0 M Phone No. 77a- 370-6775L Fill in fee simple Title Holder on next page(if different E-Mail: ©CVP,$WJ•(C� /V7-, NIE► from the Owner listed above) State or County License: iZC000?.07a if value of construction is$2500 or more,a RECORDED Notice of Commencement is required. DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY•i, _Not Applicable Name- Name: .�'' I Address: Address: I City: State: City: I' State: Zip: Phone: Zip: Phone-! 'i FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: ' . j_Not Applicable Name: Name: Address: Address: I I City: City: I I' Zip: Phone: Zip: Phone: I OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do the work and installation as indicated. I certify that no work or installation has commenced prior to the issuance of a permit. 1 St.Lucie County makes no representation that is granting a permit will authorize theper m it holder to build the subject structure which is in conflict with any applicable Home Owners Association rules,bylaws or and covenants that may restrict or prohibit such structure.Please consult with your Home Owners Association and review your deed for any restrictions which may apply. In consideration.of the granting of this requested permit,I do hereby agree that I will,in all respects,perform the work in accordance with the approved plans,the Florida Building Codes and St.Lucie County Amendments. The following building permit applications are exempt from undergoing a full concurrency review:room additions, accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use WARNING TO OWNER:Your failure to Record a Notice of Commencement may result in your paying twice for improvements to your property.A Notice of Commencement must be recorded and posted on the jobsite before the firs inspection. If you intend to obtain financing, consult with lender or an attorney before commencing4ork or peording your Notice of Commencement. Signature o Owner/ gent/Lessee Signatureof ntracto'r/License Holder i STATE OF FLORL STATE OF FLORID COUNTY OF _ COUNTY OF The forgoing instrument was acknowledged before me The forgoing instrument was a'knowl,l dged before me this day of ( M-h .201') by this day of. 20f 7 by i (Name of person acknowledging) (Name of person ackn iedging) ! . (Signature of Notary Public-Stat&of Florida) (Signature of Notary Public-State o Florida) Personally Known OR Produced Identification Personally Known _ORIIProlluI d Identification Type of identification Produced Type of Identification Produc� ��ttt ���®i Commission No. ea LASHAHNA INGRA ission No. e ;SPµv n�8 o � ? ,�• . Notary Public-State of lorida _ Fas Doc = 1 —�y• ornmission#FF 177249 o: OFF g REVIEWS FRONT Z I •�� Bon eSldrQ�gh�i�alsS� oary� S VEGETAIf.y , MANGROVE COUNTER REVIEW°�i�.oG ..�� •�� o�< REVIEW DATE �!° Nniili RECEIVED j DATE COMPLETED Rev. I �,